6Sleep patterns of the older adult include which of the following: (Select all that apply)A. Need more sleep than younger adultsB. Take longer to fall asleep than younger adultsC. Awake more frequently and stay awake longer than younger adultsD. Frequent awakening is often due to physical discomfort and nocturia

25Nursing Diagnoses for SleepSleep Deprivation: Occurs over long periods of time and symptoms more severe (confusion, even psychosis)Disturbed Sleep Pattern: time limited sleep pattern. Ex.: related to hospitalization – can be treated by nursing therapy

27Correct Answer: CNarcolepsy is excessive sleepiness in the daytime that can cause a person to fall asleep uncontrollably at inappropriate times (sleep attach) and result in physical harm to self or others

28The nurse is planning a teaching program for a patient with a diagnosis of obstructive sleep apnea. Which is the most common intervention that the nurse should plan to discuss with this patient?A. Encouraging sleeping in the supine positionB. Using devices that support airway patencyC. Positioning two pillows under the headD. Administering sedatives

30Which is the most important nursing intervention that supports a patient’s ability to sleep in the hospital setting?A. Providing an extra blanketB. Limiting unnecessary noise on the unitC. Shutting off lights in the patient’s roomD. Pulling curtains around the bed at night.

31Answer: BNoise is a serious deterrent to sleep in a hospital. The nurse should limit environmental noise (distributing fluids, providing treatments, rolling drug and linen carts) and staff communication noise.(Turning off the lights is unsafe. You may dim the lights or put a night light on to provide enough illumination for safe ambulation to the bathroom)

32What concept associated with sleep should the nurse consider to best plan nursing care for a hospitalized patient?A. People require eight hours of uninterrupted sleep to meet energy needsB. Frequency of nighttime awakenings decreases with ageC. Fear can contribute to the need to stay awake.D. Bed rest decreases the need for sleep.

33Answer: CFear of loss of control, the unknown, and potential death results in the struggle to stay awake, which interferes with the ability to relax sufficiently to fall asleep.

55When? On admission Before and after procedures or treatmentsWith each assessment/vital signsWhen the patient is resting as well as during activityBefore you give pain meds and 30 minutes afterWhen the patient complains of pain

56Where? Where ever the patient is and whatever is going on?Resting in bedAmbulatingBefore, during, after procedures whether in the patient’s room or in another location

57How? Begin with a pain history Do you have pain now?When did the pain begin? (Onset)Where is the pain located? (Location)How do you rate your pain? (use a pain scale) (Intensity)How would you describe your pain? (Quality)

58How? (Pain History) How often do you have pain? (Frequency)What makes the pain better? (Alleviating Factors)What makes it worse? (Aggravating Factors)Do you have any other symptoms when you are experiencing pain, i.e. nausea/vomiting? (Associated Factors)

59How? (Pain History)Have you experienced this type of pain in the past? If so, how did you manage/cope with it? (History of Previous Pain Experience)Have you used any medications to treat the pain? If so, what have you used and was it effective?What, if any, alternative treatments have you used for pain?

60Review: Assessing Pain How do we assess?Onset of symptomsLocationIntensityQualityFrequencyAlleviating FactorsAggravating FactorsAssociated FactorsHistory of Previous Pain Experience

62Factors That May Affect Perception of PainAgeChild – may not recognize sensation of pain or may have paradoxical reactionAdolescent – may be expressed as “attitude,” anger, aggressionOlder adult – may have trouble verbalizing because of perception that pain is “normal” part of aging

63Factors that may Affect PainCultureMay impact level of pain one is willing to endureNeed to use assessment tools that are culturally sensitive

71Side/Adverse Effects of NonopioidsAcetaminophen – Can cause liver toxicity especially in patients who consume alcohol or who have liver disease. Current recommendation: maximum of 3000 mg (3g) per day as of July, 2011Aspirin – regular use can cause prolonged clotting time (bruise easily and bleed more)Other NSAIDS – gastric irritation and bleeding, use with caution in patients with impaired clotting and renal disease

75A patient has a total abdominal hysterectomy for Stage 4 ovarian cancer. What should the nurse do first when on the second postoperative day this patient reports abdominal pain at level 5 on a 1 to 10 pain scale?A. Reposition the patientB. Offer a relaxing back rubC. Use distraction techniquesD. Administer the prescribed analgesic.

78Answer: CThis is a description of referred pain, which is pain felt in a part of the body that is at a distance from the tissues causing the pain. Referred pain is related to location of pain.

79A patient has a history of severe chronic painA patient has a history of severe chronic pain. Which is one of the most important guidelines associated with providing nursing care to this patient?A. Asking what is an acceptable level of painB. Providing interventions that do not precipitate painC. Determining the level of function that can be performed without painD. Focusing on pain management intervention before pain becomes excessive

80Answer: DAdministration of analgesics around the clock at regularly scheduled intervals or by long-acting controlled-release transdermal patches maintains therapeutic blood levels of analgesics, which limit pain at levels of comfort acceptable to patients.